Smarter Claims Decisions Begin Before Payment
An end-to-end solution rooted in Value-Based Care, designed to ensure clinically appropriate, financially sustainable and high-quality healthcare outcomes. It supports healthcare funders and scheme administrators by aligning care delivery with outcomes, efficiency and affordability.
Talk to us about moving your scheme onto proactive risk management.
At a Glance
- Claims evaluated before payment, not after
- Reference pricing and tariff validation
- Clinical and utilisation rules applied in real time
- First-year savings of 8% to 15% are typical
Many healthcare costs are only discovered after a claim has already been paid.
By then, duplicate submissions, clinical anomalies, utilisation issues, pricing inconsistencies and potential fraud may already have affected medical aid expenditure.
Traditional retrospective reviews can only identify problems after losses have occurred.
Value263
Value263 was created to shift healthcare risk management from reactive review to proactive intervention.
As NH263's Health Risk Management Hub, the platform evaluates claims in real time, applying advanced pricing, utilisation and clinical decision rules before payment decisions are made.
The result is stronger financial control, improved benefit protection and better healthcare outcomes.
Four Pillars of Value263
Automation
Real-time claims adjudication eliminates manual reviews and accelerates decision-making.
Pricing Controls
Reference pricing, tariff validation, formulary pricing and reimbursement controls help contain escalating healthcare costs.
Utilisation Management
Clinical protocols, frequency checks, ICD-10 validation and appropriateness rules ensure benefits are used responsibly.
Advanced Analytics and Intelligence
Using real-time and historical claims data, Value263 identifies emerging risks, anomalous behaviour, utilisation trends, fraud indicators and future cost drivers.
Typical Outcome
Clients commonly achieve first-year savings of 8% to 15% while improving benefit governance and member protection.
Explore Value263
Move from paying claims to actively managing healthcare risk. Prefer to talk it through first? Our team can walk you through how Value263 fits what you already run. See the Architecture.